For most women, vaginismus comes as a surprise. Though they are biologically normal, difficulties with penetration or ongoing vaginal tightness and pain seem to start mysteriously and continue repeatedly. Sometimes there is noticeable pain experienced that triggers the initial problem; however, for many, the contributing factors are subtle, and not always identified.
Even if you and your doctor can identify the cause of your vaginismus, that doesn't mean you will determine the best treatment: an exception is for those with coexisting pain-causing issues that would require diagnosis and simultaneous medical treatment to be able to progress with vaginismus resolution. However, not knowing the specific causes will not impede your recovery.
Regardless, the mixture of causes is often baffling. Consider:
- Mature women who have had years of normal, enjoyable intercourse, yet suddenly encounter painful tightness.
- Young couples that are blind-sided when they are unable to consummate their marriage, and are left puzzled for answers.
- Thousands of young women who hopelessly struggle and fail at tampon insertion, yet have no discernible life experiences to blame.
Needless to say, the causes are not always apparent.
In fact, one of the reasons that vaginismus is so often misdiagnosed, is that physicians might initially look for a simple cause-and-effect explanation. And one of the reasons women shy away from medical attention is their difficulty in explaining the causes of their condition when asked.
It is frustrating when our bodies don't respond the way we want, and it can be so difficult to explain. So, what DO WE KNOW about the causes of vaginismus?
The Role of the Limbic System in Causing Vaginismus
Vaginismus cannot be understood without first recognizing the internal reaction causing involuntary tightness. Within the brain and nervous system, there are a set of structures that perceive sensory information and control reactive bodily functions called the limbic system. With vaginismus, vaginal muscles tighten in limbic reaction to false sensory concerns of danger in various forms of touch, pelvic vulnerability, or the negative anticipation of potential penetration. For this reason, some physicians describe vaginismus as a fight or flight reaction in the pelvic floor and surrounding musculature. The body interprets signals incorrectly, responding with intense, internal body tightening and reflexive movement away from potential penetration.
The muscles are not permanently tightened – they tighten when the limbic system sounds the alarm, then returns to normal when the danger-concern is over. However, the cycle of tightening tends to repeat in a perpetual, ongoing basis until the problem is properly treated and resolved (see The Cycle of Pain, below).
Emotional anxieties, or unhealthy sexual messages, can contribute to and reinforce the initial symptoms of vaginismus, but so can a pelvic pain experience (simply any pain experience in the pelvic area, or a sexual pain experience). Something as simple as a childhood urinary tract infection could start an issue in the limbic system where vaginal pain will be felt again. There may be numerous emotional anxieties like this, from deep-seated emotions to distant memories of pain or fear associated with those parts of the body or with sexual activity in general.
Here is a sample list of wide-ranging experiences that could contribute to developing the vaginismus condition:
Fear, Anxiety, Shame, or Embarrassment
- Fear of pain
- General anxiety
- Fear of hymen breaking, tearing
- Fear of bleeding
- Fear that the vaginal is too small or might be injured
- Fear of pregnancy
- Anxiety about being vulnerable or naked
- Fear of performance inadequacies
- Concerns about urination control
- Not feeling ready for sex
- General negativity towards sex
- Feeling ashamed or embarrassed
- Poor sex experiences resulting from insufficient foreplay or inadequate lubrication
- Frustration from failed tampon insertion attempts
- Difficult pelvic examination
- Difficult labor experiences / fear of not being completely healed afterwards
- Overly rigid parenting experiences as a child
- Unbalanced religious teaching about sex
- Inadequate sexual education
- Fearful / overprotective parents towards sex
- Early exposure to pornography or graphic stories
- Awareness of stress related to unplanned sibling pregnancies
- Fear of losing control of situations
- Uncertainty about the relationship
- Fear of commitment
- Dislike of partner
- No foreplay / insufficient arousal
- Rough sex
Physical or Emotional Trauma
- Surgery or other pelvic trauma condition
- Rape or assault
- Witness of violence or abuse to others
- Past sexual or emotional abuse
- Repressed memories
- Age-related changes/vaginal atrophy/hormonal changes
- Temporary sexual discomfort
- Disabling medical conditions
- Pain from cancer
- Vulvodynia / Vestibulodynia
- Lichen sclerosis
- Yeast infections
- Urinary tract infections
- Genital or pelvic tumors
- Vaginal prolapse
- Irritation from lubricants
- Pelvic trauma
- Any type of temporary or long-term pelvic pain
No explanation for condition
- Vaginismus does not always have an obvious cause. Sometimes women with near-perfect childhoods, great relationships, no physical problems, and few anxieties, have trouble identifying a trigger to their vaginismus. The cause might remain a mystery even after vaginismus is fully resolved.
Life experiences vary dramatically from person to person. These experiences might trigger vaginismus in some women but not in others. If, in reviewing your life, you remember unresolved trauma, professional counseling may be beneficial to your mental health.
With vaginismus, the mix of various experiences – such as those examples listed above – cause the limbic system to be in a heightened state of concern and to respond incorrectly to normal, healthy activity. The body response then develops into an entrenched vaginismus condition through a cycle-of-pain experience:
Understanding the Vaginismus Cycle-of-Pain
1. Anticipate Pain: Various life experiences can cause the limbic system to be in a heightened state of sensory reactivity toward the possibilities of pain or danger to the pelvic area. Intercourse, touching, or pelvic vulnerability might trigger the body's limbic alarm.
2. Involuntary Reaction: The limbic alarm causes the body to react incorrectly by tightening up the vaginal muscles to protect itself from potential pain or harm from a person or object.
3. Painful Sex: With the vaginal muscles in a tightened state, sex is uncomfortable or painful between a couple or partners. Penetration might be difficult or even impossible, depending upon the severity of the tightness of the woman.
4. Pain Reinforces: Attempts at sex result in discomfort, pain, or failure, and these experiences further reinforce and "validate" the limbic system's need to continue reflexively reacting and protecting the body.
5. Bracing: The body continues to react with intensifying concerns, strongly tightening to protect itself against any further pain or discomfort. Any attempts at intercourse are met with immediate muscular bracing and ongoing tightness across the pelvic floor and body.
6. Avoidance: Ongoing failure, pain, and discomfort have the effect of greatly diminishing the desire to be sexually intimate. Ultimately, sex avoidance results between a couple or partners. Forced attempts at sex only serve to repeat the same cycle again. The negative experiences fully entrench vaginismus in a woman, and without treatment resolution, the body will stay in this state of limbic response and failure.
Vaginismus is NOT the Sufferer's Fault
The limbic alarm that causes the vaginismus cycle-of-pain can be triggered by any mix of physical and non-physical experiences sometimes going all the way back to childhood experiences. Vaginismus is not the woman's fault and is not intentional—the tightening occurs without conscious direction and often without awareness of the woman. The limbic system reacts by itself, to where the sufferer cannot simply stop the reaction without a resolution treatment process.
It is incredibly frustrating to be unable to physically engage normally.
Vaginismus caused by Other Medical Conditions
Vaginismus is often a complicating factor in the recovery process from other pelvic pain conditions. Vaginismus may co-exist with other medical conditions, triggered by direct pain or heightened anxiety about the continuation of sex potentially causing discomfort, pain or damage. When the original condition has been resolved or managed, yet ongoing tightness and discomfort remains, it is typically due to vaginismus.
In cases where there is clearly both vaginismus and another pelvic medical problem existing simultaneously, both problems need to be treated to ensure full resolution. Without addressing the original medical issue, it will be difficult to resolve vaginismus as it may continue to be triggered by pelvic pain from the other problem. Conversely, after the original pain condition has been addressed, the ongoing problem of vaginismus will also need to be treated.
For example, a woman who undergoes pelvic cancer surgery may have heightened underlying anxiety about her body not being fully healed from the stitches where an incision was made. The anxiety is less emotional and more of a complex body memory of recent trauma and tissue recovery pain. The limbic system senses the mix of general physical and internal emotional anxiety, which involuntarily causes the muscles in the pelvic floor to partially tighten to protect the vaginal area from pain or damage, especially when attempts to resume intercourse begin. The partially tightened muscles cause intercourse attempts to be uncomfortable or painful, increasing the limbic system reaction response and making the body overreact in the future with even greater tightness—an ongoing cycle-of-pain.
There are countless situations of vaginismus and other medical conditions, ranging from the young mother recovering from labor trauma to the mature woman with age-related conditions. The body acts in limbic response when it perceives that penetration is not safe, even though the original physical or medical condition may have been fully resolved.
Fortunately, vaginismus is fully treatable and can be completely resolved.